Lead Repair: Master Electrode Repair Coding Conundrum

Learn how to code lead repair as well as battery change at same session.

Medical coding for electrode repair is slightly clearer in 2012.

In 2011, your electrode (lead) repair choices for a pacemaker (PM) or implantable cardioverter-defibrillator (ICD) involved these two CPT codes:

33218 (Repair of single transvenous electrode for a single chamber permanent pacemaker or single chamber pacing cardioverter-defibrillator)

33220 (Repair of 2 transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator)

Problem: As per the wording in the 2011 definitions, neither code appeared suitable for repair of a single lead in a dual-chamber system. Code 33218 denoted a single lead in a single-chamber system, as well as 33220 denoted repairing two leads in a dual-chamber system. At one point, AMA's Principles of CPT® Coding (fourth edition) suggested reporting 33220-52 (Reduced services) to signify repair of a single electrode in a dual-chamber device.

2012 solution: CPT 2012 revises the code definitions to refer only to the number of electrodes and not the number of chambers involved:

33218 (Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator)

33220 (Repair of 2 transvenous electrodes, permanent pacemaker or pacing cardioverter-defibrillator)

Based on the above definitions, the suitable code for single-electrode repair when the date of service is on or after Jan. 1, 2012, appears to be 33218.

Battery Change + Lead Repair = Multiple Codes

Owing to changes elsewhere in the PM and ICD range of CPT®, the codes you'll pair with 33218 and 33220 for lead repair at the same session as a battery change have a new look.

A note with 33218 tells that when the physician repairs a single electrode for a PM or ICD at the similar session as pulse generator replacement, you must report 33218 with the correct code from:

33227-33229 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator…)

33262-33264 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator …)

Code 33220 has its own individual new note asking you to report repair of two transvenous electrodes and generator replacement at the similar session using 33220 in conjunction with the single suitable code from:

33228 (dual lead PM battery change)

33229 (multiple lead PM battery change)

33263 (dual lead ICD battery change)

33264 (multiple lead ICD battery change).

Problem: CCI edits 2012 shows edits bundling dual- and multiple-lead PM battery changes (33228-33229) with single lead repair CPT 33218. The edits have a modifier indicator of 0, so you may not override the edits. The edits as mentioned in CCI edits 2012 could cause reporting problems if the physician repairs a single lead at the same session as a battery change for a dual- or multiple-lead system.

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New CCI Edits Inverse 'No-Go' Status of Injections With Some Vascular Procedures

New CCI Edits Inverse 'No-Go' Status of Injections With Some Vascular Procedures

The newest edition of Correct Coding Initiative (CCI) edits holds some pleasant revelations for neurology and pain management coders.

CCI Edit, Medical Coding

Go to 'deleted edits' section for updates to paravertebral facet joint injections.

The newest edition of Correct Coding Initiative (CCI) edits holds some pleasant revelations for neurology and pain management coders. In place of being burdened with added CCI edits that limit your claims filing, most pairs linked to neurology or pain management in fact fall under the "deleted edits" category. Read this article for accurate medical coding.

As far as the terminated pairs are concerned, 218 were retroactively ended back to the last quarter release and one back to January 1, 2010. This simply implies that, in case you were denied payment owing to these edit pairs in the past, you would probably be able to resubmit the claim for payment at this time.

Medical Coding Tip: Verify Deletions for Injection/ Vascular Procedure Bundles

Terminated bundles have influence on three groups of procedures carried out by neurologists or pain management specialists: therapeutic or diagnostic injections, paravertebral facet joint injections (with either image or ultrasound guidance), as well as somatic nerve injections.

The affected diagnostic or therapeutic injection codes involve the following:

96372 – i.e. Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); along with subcutaneous or intramuscular

96374 -- i.e.Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); along with intravenous push, single or initial substance/drug

96375 -- i.e.Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); every additional sequential intravenous push of a novel substance/drug (List separately in addition to code for primary procedure)

A couple of Category III codes also come into the "deleted pairs" group:

0213T – {Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level}

0216T – {Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.}

Furthermore, preceding CCI edits bundled the bulk of somatic nerve injections 64400-+64484 (Injection, anesthetic agent …) as well as paravertebral facet joint injections 64490-+64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] …) into an extensive range of intra-arterial as well as venous procedures. As per new CCI edits, those bundles are deleted. .

Example: Previous CCI edits listed the listed injections as constituents of vascular procedures for instance 36000 (Introduction of needle or intracatheter, vein), 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]), as well as 36425 (Venipuncture, cutdown; age 1 or over). For error-free medical coding, You must verify your claims after Oct. 1 to double-check whether some of the preceding bundles might now be permitted, and if you can refile claims owing to retroactive changes.

Article Source :- http://www.supercoder.com/coding-newsletters/my-neurology-coding-alert/cci-update-new-cci-edits-reverse-no-go-status-of-injections-with-some-vascular-procedures-108436-article

99211 Coding Quiz: Can You Identify Which of These Quick-Visit Services Qualify for 99211?

Hint: You can't automatically tack 99211 on to every service just because the nurse was present.

Most practices agree that 99211 is a ubiquitous code, reported nearly every day for visits ranging from blood pressure checks to medication updates. But the so-called "nurse visit" code may not always be appropriate. Many MACs are scrutinizing these claims and targeting them as "areas of concern," as WPS Medicare did this past April. Check out these common clinical scenarios and determine whether 99211 is appropriate for the circumstances.

Know Whether 99211 Applies to X-Rays

Question 1: A patient comes to see the physician for a leg problem. The staff performs x-rays and then the patient waits in the exam room for the doctor, but gets a call and has to leave before she actually sees the physician. Does 99211 apply to this visit?

Answer 1: "What is unanswered is was the x-ray ordered by the doctor?" asks Ruby Woodward, BSN, ACS-OR, coding and research specialist at Twin Cities Orthopedics in St. Louis Park, Minn. "If the physician ordered and read it, bill the x-ray unmodified. If the physician did not order the x-ray, then nothing can be billed."

In short, Woodward says, you cannot report 99211 unless an actual evaluation and management service was provided.

Will 99211 Cover Vaccines?

Question 2: A patient presents for vaccines only. The nurse administers two vaccines and the patient leaves. Should you report 99211 with the vaccine administration codes?

Answer 2: Not as a rule, no. If the nurse simply administers a vaccine and the patient leaves, the nurse most likely has not met the criteria for billing 99211. If, however, the nurse spends a lot of time counseling the patient or the patient has other diagnoses that the nurse goes over, then 99211 might be appropriate.

In some cases, depending on the CCI edits for the specific vaccine codes you're using, you may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211.

In black and white: "Services billed to Medicare under CPT code 99211 must be reasonable and necessary for the diagnosis and treatment of an illness or injury," says a policy on 99211 written by Part B MAC WPS Medicare.

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Do Not Miss Out On Ancillary Procedures with Kyphoplasty, Vertebroplasty

Report radiologic supervision and interpretation, however leave out bone biopsies.

When your orthopedist carries out a vertebroplasty or kyphoplasty procedure, you will need to decide if there are additional services you could be coding and reporting. Get the low down on what you can and cannot report separately.

Modifier 26 brings you radiology pay

You can report the operating surgeon's imaging for needle positioning and injection assessment during a kyphoplasty or vertebroplasty procedure. You will use either 72291 or 72292 in addition to fluoroscopic guidance.

CPT revised these codes for 2006 to use with either vertebroplasty or kyphoplasty. You should be sure to append modifier 26 (PC) to the appropriate radiology service code to show that the surgeon provided only the physician component of the service and didn't supply the equipment, etc.

Caution: If your surgeon doesn't personally carry out the guidance, you can't bill for it. Rather, the healthcare professional who provides the service (often the facility radiologist) will bill for it.

Include bone biopsy with main procedure

When you are reporting 22520-+22522 or 22523-+22525, you won't code separately for a bone biopsy. You shouldn't report 20225 if the biopsy occurs at any of the same spinal levels as the primary procedure.

Here is the reason: The CPT code descriptors stimulate this limitation as do many payer local coverage determinations (LCDs). To add to it, CCI edits(http://www.supercoder.com/coding-tools/cci-edits-checker/) bundle bone biopsy to vertebroplasty and kyphoplasty codes. As there's boney tissue removed during the process anyway, it wouldn't be right to charge for taking some specifically for a biopsy.

Alternative: If your surgeon carries out bone biopsy at a level not addressed by the vertebroplasty or kyphoplasty, but you may report the biopsy separated with modifier 59 (distinct procedural service) to indicate the unrelated nature and separate locations of the two procedures.